Are Decreased BP And Pulse Rate An Indication Of The Ineffectiveness Of CCB?

Posted on Fri, 25 May 2018

Question: Hello Doctor,

You had suggested that she can take CCB Angizem which is safe . She stopped stamlo 2.5 mg which she use to take 2 times a day and from today she started with Angizem which the doc had also recommended it will work for both pulse and BP but looks like her BP and pulse have not gone down with that . Her BP is 145/90 and pulse is 95.

Does this mean that the CCB Angizem is not working on her? Can you please guide me here.

Also, you had recommended to do the sleep study , we will do that next week. But if the results are positive does she has to use CPAP machine? and if yes, does that machine makes some noise ? and which company is the best one to buy and particularly which device .

I am attaching the reports again for your reference .

Answered by Dr. Drkaushal85 (42 minutes later)

Brief Answer:
Yes, CCB is not working in her.

Detailed Answer:
Thanks for your direct query on Healthcare Magic.
I can understand your concern.

Yes, it is possible that CCB is not working for her.
In my opinion, you should start Stamlo twice daily.
Also give Metoprolol 25 mg once a day in the morning after breakfast.
Metoprolol is beta blocker group of drug. It will control both, blood pressure and heart rate.
CPAP need is entirely depends on sleep study report.
If she found to have OSA (obstructive sleep apnea), then titration study (repeat sleep study with CPAP) is needed to identify pressure requirements in her case.
According to titration report, CPAP machine is prescribed.
Philips is pioneer in making CPAP machines. So if you need to buy one then go for Philips.
Newer machines are very silent. So no need to worry for noise.

Hope I have solved your query. I will be happy to help you further.
Wishing good health to your mother.
Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Drkaushal85 (23 minutes later)

Hello Doc

Should beta blocker be taken with asthma puff?? And should we wait to see the effect of CCB for 2 days and see the effect??

Also CCB wont work for hypertention and pulse ??

Please advice

Regards
XXXX

Answered by Dr. Drkaushal85 (36 minutes later)

Brief Answer:
Yes, cardio selective beta blocker is safe in asthma patients.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.

Cardio selective beta blocker is safe in asthma patients.
Metoprolol is cardio selective beta blocker.
So no need to worry for metoprolol.
CCB is working more in control of heart rate than blood pressure.
Does she have worsening symptoms after changing drugs (stopping Stamlo and starting CCB)?
If CCB is not working then metoprolol and Stamlo should be started.

I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Drkaushal85 (1 hour later)

Hello Doc

Symtops have not worsen after changing drug from stamlo to angizem. But my worry is you also daid after reviewing the reports both ecg echo and pft that she has tachycardia but the reports are ok nothing to worry.

But i fail to understand why the CCB is not working in her case ideally she has started blood pressure table for the 1st time in her life. And its been a week. And since pulse were high the doctor suggested angizem which shud work for both bp and pulse but again this too has not shown any much effects

Her bp is still 135 or 140 / 85

Should we wait for atleast 2 days to see if the angizem is working ??
Kindly advice please

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
Since she is asymptomatic, you can continue with CCB.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Since she is asymptomatic, she can continue with CCB.
We can wait for 2-3 days for CCB to work.
Some drugs don't show desired effects in some individuals.
So wait for 2-3 days more.
If even after 2-3 days, her BP and pulse rate don't decrease then start metoprolol and Stamlo.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Drkaushal85 (38 hours later)

Hello Doc

Thanks for all your advice
I have two questions here
My mom is not getting sleep like she is up for the whole night almost soo will sleep study show proper results if she is awake?
Second she is having cough can we give her montair 10mg or mondeslor 10mg once a night which one should be goiven pls advice

Her current tablet which she is taking are as below kindly advice if this montair or monfeslor will interfere with the bwlow tablets
Angizem 90cd
Rozaval F 10
And budecort puff

Please advice

Answered by Dr. Drkaushal85 (18 hours later)

Brief Answer:
Sleep study will not give proper results if she is awake at night.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Sorry for late reply as I was busy.
Sorry to say but sleep is needed for sleep study.
This won't be possible if she is not sleeping in night.
Montelukast is anti allergic drug. It is not direct cough suppressant. It reduces allergy and its effects (itching, coughing).
I don't know what does mondeslor 10mg contain.
Please let me know if it contains any antihistamine (levocetrizine or fexofenadine or desloratidine).
Montelukast plain will not interact with other drugs you have mentioned.
I need to know contains of mondeslor to guide you about interactions.
I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Drkaushal85 (2 hours later)

Hello doc,

1. Montair tablets 10mg contain the active ingredient montelukast sodium, which is a leukotriene receptor antagonist that prevents leukotriene-mediated inflammation in asthma and allergic rhinitis, reducing swelling and mucous secretion in asthma and relieving symptoms like nasal congestion, runny nose and sneezing in ...

2. Composition for Mondeslor Tablet : Desloratadine (5mg), Montelukast (10mg)

Primarily used for Allergic disorders, Asthma prophylaxis. Montelukast is used in asthma prophylaxis, exercise-induced asthma and allergic rhinitis symptoms.

Please advice if she can take which one of the above for
1. Cough at night and morning
2. X ray report is normal but can u suggest any other tests to rule out what could be the reason for cough ?

Answered by Dr. Drkaushal85 (33 minutes later)

Brief Answer:
Better to take mondeslor.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Better to take mondeslor tablet because it contains both, montelukast (anti allergic) and desloratidine (antihistamine).
She can go for HRCT(high resolution CT) thorax.
HRCT thorax is more informative than chest x ray.
Sometimes chest x ray can be normal and we found lesions in lungs and mediastinum on HRCT.
So HRCT can be done in her case to find out cause for cough.
Has she undergone HRCT thorax before?
I will be happy to help you further. Wishing good health to your mother. Thanks.

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Above answer was peer-reviewed by : Dr. Kampana